Care Management Coordinator - Field - OhioRISE Central/SE Ohio

Position Summary

This is a full-time field-based telework position in Ohio. The position requires the ability to travel within the assigned region of Ohio to member homes and other requested member locations, up to 50% or more of the time.

Applicants must reside in central or southeastern Ohio. Preferred counties: Ashland, Athens, Coshocton, Delaware, Fairfield, Fayette, Gallia, Guernsey, Highland, Hocking, Holmes, Jackson, Knox, Licking, Meigs, Morgan, Morrow, Muskingum, Noble, Perry, Pickaway, Pike, Richland, Ross, Vinton, Washington and Wayne.

Monday-Friday 8‑5pm with flexibility needed to work later to meet member needs.

Business Overview

As part of the bold vision to deliver the Next Generation of managed care in Ohio Medicaid, OhioRISE helps struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program provides comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child‑serving systems.

Fundamental Components

• Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child‑serving systems.
• Evaluation of Members:
  • Through the use of care management tools and information/data review, conduct comprehensive evaluation of referred member's needs/eligibility and recommend an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services. Identify high‑risk factors and service needs that may impact member outcomes and care‑planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
  • Coordinate and implement assigned care‑plan activities and monitor care‑plan progress.
• Enhancement of Medical Appropriateness and Quality of Care:
  • Using a holistic approach, consult with case managers, supervisors, Medical Directors and/or other health/behavioral health programs to overcome barriers to meeting goals and objectives; present cases at case conferences to obtain multidisciplinary review to achieve optimal outcomes.
  • Work collaboratively with the members' Child and Family Teams.
  • Identify and escalates quality of care issues through established channels.
  • Utilize negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
  • Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
  • Provide coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
  • Help member actively and knowledgably participate with their provider in healthcare decision‑making.
  • Serve as a single point of contact for members and assist members to remediate immediate and acute gaps in care and access.
• Monitoring, Evaluation and Documentation of Care:
  • Utilize case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Required Qualifications

• 2+ years of experience in behavioral health, social services, or human services
• 2+ years of experience with personal computers, keyboard and multi‑system navigation, and MS Office Suite applications (Outlook, Word, Excel, SharePoint)
• 2+ years of experience in children's mental health, child welfare, developmental disabilities, juvenile justice, or a public sector human services or behavioral health care field, providing community‑based services to children and youth, and their family/caregivers
• 2+ years experience in one or more of the following areas of expertise: family systems, community systems and resources, case management, child and family counseling/therapy, child protection, or child development
• 2+ year of experience with Ohio delivery systems, including local community networks and resources
• Willing and able to travel within the assigned region up to 50% of the time; some travel to the New Albany office may be required for trainings/meetings
• Reliable transportation required
• Mileage is reimbursed per our company expense reimbursement policy
• Willing and able to work beyond core business hours of Monday‑Friday, 8am‑5pm, as needed
• Bachelor's degree or non‑licensed master level clinician required
• Must reside in Ohio

Preferred Qualifications

• Case management and discharge planning experience
• Managed Care experience
• Medicaid experience

Education

Bachelor's degree or non‑licensed master level clinician required, with either degree being in behavioral health, human services, health services, or public health preferred (e.g., psychology, social work, marriage and family therapy, counseling, juvenile justice).

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

$21.10 - $40.90

This pay range represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above.

Benefits

• Affordable medical plan options, 401(k) plan (including matching company contributions), and employee stock purchase plan
• No‑cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility

EEO Statement

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.